By: David Seaton MA, Christina Edwards MHA
Culture change refers to the national movement that began in the mid-1990s that calls for the transformation of long-term care services for elders and individuals with disabilities.
Culture change considers and respects the person-centered values of the individual receiving care and the people who provide care to the individual. Choice, dignity, respect, support, self determination, and pursuing purposeful living are the core person-centered values of culture change.
In a long-term care setting, culture change adoption requires changes in an organization’s practices, physical environments, and decision-making processes at all levels in order to provide person-centered care. These adjustments help an organization create a permeable environment that listens and adjusts to residents’ needs. It also helps organizations push past the plateau of complacency commonly seen in both residents and caregivers in long- term care. Higher satisfaction ratings from residents, family, and staff come out of promoting respectful relationships, supporting self-determination, and pursuing a purposeful life.
In Texas, culture change has reached to nursing homes for elders, long-term care settings for individuals with disabilities, and has affected legislation concerning state supported living centers. Though Texas still has a long way to go on the journey to making culture change the norm in long-term care, there are leaders and supporters in the field that can serve as inspiration and examples for future progress.
Culture Change in Texas
Today there are approximately 4,122 long-term care facilities in Texas that serve more than 200,000 Texans (Texas Culture Change Coalition, 2011). Long-term care facilities for elders and individuals with disabilities provide continuous care to those who cannot care for themselves independently. Traditionally, long-term care facilities provide system-centered, custodial care and are run in a top-down form of management. Residents follow the rules of the facility and have little control over their schedules, activities or treatment. This institutional model of long-term care is common throughout the country, and Texas is not unique in this respect. However, some long-term care facilities in Texas choose to provide person-centered care and have moved away from the traditional system-centered model. The Texas Long Term Care Institute (the Institute) and the Texas Culture Change Coalition (TxCCC) are two entities that support and promote the adoption of culture change through research, training, education, and advocacy.
Promotion of Culture Change in Texas
The Texas Long Term Care Institute
The Texas Long Term Care Institute has been funded by the Texas State Legislature since 1993. Based out of Texas State University, the Institute has become a leader in the culture change movement through research and training. The Institute partners with other entities and conducts research in order to support systematic improvements to long-term care practices.
Just a few of the topics studied by the Institute include: determining the effectiveness of changing nurse staffing structures in nursing homes, the effectiveness of dance therapy in treating patients with Alzheimer’s, and surveying the perceptions of long-term care nurses concerning quality care (Texas State University, 2011). In 2011, the Institute partnered with the Texas Culture Change Coalition to host the first culture change symposium in Texas, and continually works with TxCCC to increase awareness of culture change practices.
The Institute has provided research on the effectiveness of the Eden Alternative in Texas long-term care facilities. In the year 2000, researchers from the Institute observed the effects of Eden Alternative implementation in nursing homes in Texas. The study found increases in the following areas when the Eden Alternative was introduced into the sample nursing homes: resident independence, level of staff support for residents, and life satisfaction in residents. The main issue that became clear from this study was that effective leadership is the key to adopting the Eden Alternative (and thusly culture change) into a long-term care facility. In some instances, administrators and managers became obstacles to successful culture change adoption when they were not completely supportive of the process. The study determined that successful implementation of culture change completely hinges on quality leadership (Willie, 2001).
Texas Culture Change Coalition
In January of 2011, the Texas Culture Change Coalition (TxCCC) was founded by professionals, providers, and organizations in Texas focused on improving long-term care services for elders and individuals with disabilities. TxCCC is a nonprofit organization that brings together various individuals who wish to promote culture change adoption in Texas. These individuals meet together to offer their insights on policy, regulations, training, education, and other forums that can promote culture change in Texas. The coalition aims to bring various stakeholders to the culture change table, and include them in the journey of moving away from traditionally accepted “custodial” care practices and toward positive lifelong living environments in long-term care. These stakeholders can be providers, advocates, organizations, regulators, family members of individuals receiving care, or any other person interested in promoting culture change.
At the core of TxCCC, its members acknowledge that culture change recognizes the unique interests and needs of the individual receiving care, and centers care around the person. The coalition also emphasizes that culture change affects both elders and individuals of all ages with disabilities. The objective of TxCCC is to support the transformation of motivated organizations into person-centered care communities through education and training (Texas Culture Change Coalition, 2011).